Recent articles by Rao and colleagues [1] and Frobert and colleagues [2] add to the extensive literature about the esophagus as a cause of chest pain in patients who do not have coronary artery disease. An equally important issue is the misdiagnosis of esophageal disease in patients with acute coronary syndromes.

A report based on 10 years of data from the PHICO insurance company (a medical malpractice carrier) involving myocardial infarction that was not diagnosed in the emergency department showed that a gastrointestinal diagnosis was made in 35% (24 of 64) of the claims [3]. A finding in some misdiagnosed cases was relief of symptoms with the “gastrointestinal cocktail.”